OBH Maternal & Infant Health Series Part 1: "Giving NICU Babies the Best Start "

1) Why is breast milk especially important for premature and medically fragile babies?

Breast milk is especially important for premature and medically fragile babies because it is the ideal nutrition for their developing bodies. Premature infants have immature digestive systems, and breast milk is easier to digest and better tolerated than formula. This allows many babies to reach full milk feedings sooner, reducing the need for prolonged intravenous nutrition.

One of the greatest benefits of breast milk is that it significantly lowers the risk of necrotizing enterocolitis (NEC), a serious and potentially life-threatening intestinal disease. NEC is one of the most feared complications in the NICU, and human milk is one of the most effective strategies we have to decrease the incidence of NEC and help protect premature infants.

Breast milk also provides antibodies and other protective immune factors that help reduce the risk of infection while supporting healthy growth, brain development, and long-term health. For these reasons, we consider a mother’s own milk the preferred nutrition for premature infants whenever possible. When a mother’s milk is not yet available, pasteurized donor human milk may be used with parental consent, for eligible babies while we continue to support mothers in establishing their own milk supply.

2) How does breastfeeding or expressed breast milk support a baby’s growth, development, and recovery in the NICU?

Breastfeeding or expressed breast milk plays a critical role in helping premature and medically fragile infants grow, develop, and recover in the NICU. Because these babies have immature digestive systems, they require careful nutritional support as feedings are introduced gradually. Human milk is better tolerated than formula, allowing many infants to reach full feedings sooner while reducing their need for prolonged intravenous (IV) nutrition.

Premature infants are also at increased risk for serious infections and necrotizing enterocolitis (NEC). Research has shown that a mother’s own milk significantly reduces the risk of NEC and is the preferred source of nutrition for premature infants. When a mother’s milk is not immediately available, pasteurized donor human milk is often the next best option and offers greater protection than formula.

Breast milk also contains protective antibodies and other immune factors that help defend babies whose immune systems are still developing. Together, these unique properties support growth, improve feeding tolerance, promote recovery, and give premature infants the strongest possible start.

3) What support does Brookdale’s NICU provide to mothers who want to breastfeed or pump while their baby is hospitalized?

Brookdale Hospital is a Baby-Friendly Hospital, and our staff is educated and fully equipped to support a mother’s feeding journey. From labor and delivery to the mother-baby unit and the NICU, nurses, pediatric residents, and Neonatologists are trained to provide consistent, hands-on lactation support.

We help mothers initiate pumping, establish and maintain their milk supply, assist infants with latching when they are developmentally ready, and teach families how to safely provide expressed breast milk for their hospitalized infant.

Our support begins before delivery with prenatal education, continues throughout the NICU stay with individualized feeding plans and bedside lactation support, and extends after discharge through community programs such as Healthy Families and Healthy Steps.

Our goal is to provide families with consistent, continuous support throughout their breastfeeding journey—from pregnancy through the NICU stay and beyond.

4) What challenges do parents of NICU babies commonly face, and how does your team help them navigate those challenges?

Parents of NICU babies often face the emotional challenge of being separated from their newborn while their baby receives specialized care. That separation can be stressful and may interrupt the natural bonding process that is so important for establishing breastfeeding.

Another challenge is that many premature infants are not yet developmentally ready to breastfeed. Babies born extremely premature often lack the coordination to suck, swallow, and breathe effectively, so they initially receive expressed breast milk through a feeding tube until they are ready to safely feed at the breast.

At Brookdale Hospital, we use a family-centered, interdisciplinary approach to support families every step of the way. Our multidisciplinary team—including lactation consultants, neonatal nurses, social workers, pediatric residents, and Neonatologists, work together to provide education, encouragement, and individualized support throughout the NICU stay and after discharge.

One of the most rewarding parts of our work is seeing babies who were born three or four months early leave the NICU exclusively breastfeeding. Those successes reflect the resilience of these infants and the partnership between families and our healthcare team.

5) How does family involvement contribute to a baby’s care and recovery in the NICU?

Family involvement is an essential part of a baby’s care and recovery in the NICU. We don’t view parents as visitors—we view them as valued members of the healthcare team. From the very beginning, we encourage parents to be present, ask questions, and participate in their baby’s care as much as their baby’s medical condition allows.

Some babies, particularly those born at the limit of viability or who are critically ill, are too fragile for extensive hands-on care during the earliest days of life. During this time, parents can still play an important role by talking or reading to their baby, providing expressed breast milk, and simply being present at the bedside.

As babies become stronger, parents are encouraged to participate infant care such as feeding, diaper changes, and skin-to-skin (kangaroo) care. Skin-to-skin contact promotes bonding, supports breastfeeding, helps regulate a baby’s temperature, heart rate and glucose levels.

Our goal is to empower parents throughout their NICU journey. By partnering with families every step of the way, we not only support each baby’s recovery but also strengthen the lifelong bond between parents and their child.

6) What advancements in neonatal care have improved outcomes for premature babies?

The biggest advancements in neonatal care have come from a much better understanding of the pathophysiology of diseases that affect premature infants. One of the most significant breakthroughs was recognizing that respiratory distress syndrome is primarily caused by surfactant deficiency. The development of surfactant replacement therapy has dramatically improved survival for premature babies with immature lungs.

We’ve also made tremendous progress in respiratory support. Our approach has shifted toward gentler ventilation strategies, including early CPAP, less invasive surfactant administration, and lung-protective ventilation techniques that reduce ventilator-induced lung injury, such as barotrauma and volutrauma.

Advances in nutrition, infection prevention, thermoregulation, and family-centered care have also contributed to better outcomes. As a result, we are now able to successfully care for babies born at earlier gestational ages than ever before.

Overall, neonatal care has evolved from simply helping premature babies survive to helping them survive with the best possible long-term outcomes .

7) What are some common misconceptions about caring for premature infants?

One of the biggest misconceptions is that a premature baby is simply a smaller version of a full-term baby. That’s really not the case. Prematurity affects every organ system. The earlier a baby is born, the more immature their lungs, brain, gastrointestinal tract, immune system, and ability to regulate temperature. Caring for a premature infant is much more than helping them gain weight—it’s supporting the maturation of every organ system. Another misconception is that our premature babies are the same. Priority is defined as birth before 37 weeks gestation but prematurity is a spectrum . A baby born at 36 weeks has different challenges than a Baby born at 23 or 24 weeks gestation. Their medical needs risk unexpected hospital course  can be dramatically different.

A third misconception is that once a premature baby is feeding well, maintaining their temperature, and ready for discharge, the journey is over. In reality, discharge is just another stage as infants born prematurely benefit from ongoing follow-up with their pediatrician to monitor growth, nutrition, development, vision, hearing, and other long-term outcomes.

Ultimately, caring for premature infants requires patience. We can’t rush development. Our role is to support these babies while nature continues the maturation that would normally have occurred in the womb.

8) What advice do you give parents preparing to bring their NICU baby home?

My biggest advice to parents preparing to bring their NICU baby home is to become comfortable and confident in caring for their baby before discharge. We encourage parents to participate in their baby’s care throughout the NICU stay by feeding, learning their baby’s cues, practicing daily care, and working closely with the nursing team and support staff.

Before discharge, we provide education on important topics such as safe sleep, CPR, feeding techniques, and what to expect at home. I always encourage parents to ask questions. There is no question that is too small. Our goal is not only to make sure the baby is medically ready to go home, but also to make sure the family feels prepared and supported.

I also emphasize the importance of establishing care with their pediatrician and keeping all follow-up appointments. Some premature infants, especially those born extremely preterm, also benefit from early intervention services such as physical therapy, occupational therapy, speech therapy, and developmental follow-up clinics.

Ultimately, our goal is not just to get babies home—it is to help babies and families thrive after they leave the NICU.

9) What makes One Brooklyn Health Brookdale’s NICU unique in the care it provides to families?

What makes One Brooklyn Health Brookdale’s NICU unique is that we truly embody the mission and vision of providing high-quality, evidence-based care to the community we serve.

We are committed to providing the best care to every patient in a way that is culturally sensitive and respectful. We serve a very diverse patient population, and we want every family who comes through our doors to feel that they are receiving the same excellent care they would receive anywhere.

One of the greatest strengths of our NICU is our people. We have physicians, nurses, and staff who have been part of this community for many years, even decades. That longevity brings experience, expertise, and a deep understanding of the families we serve.

We have the knowledge, the experience, and, most importantly, a team that is deeply committed to making a difference in the lives of the babies and families we serve.

But what really makes our NICU special is that we understand we are not just caring for an infant—we are caring for a family. We partner with parents, we listen to them, and we recognize that they are an essential part of their baby’s healthcare journey.

We are honored to care for this community and the babies and families we serve. We truly believe that a healthier you starts here.

10) What message would you like families to remember about giving their baby the healthiest possible start?

The message I would like families to remember is that giving a baby the healthiest possible start begins with caring for the whole family. That journey can begin even before pregnancy by prioritizing your physical and emotional health, maintaining regular healthcare visits, and partnering with trusted healthcare providers.

But I also want families to know that every baby’s journey is unique. If your baby is in the NICU, the most important thing to remember is that you are an essential part of your baby’s healthcare team. You are not a visitor—you are a member of the team.

We are here to guide you, support you, answer your questions, and partner with you every step of the way. The love, presence, and involvement of a parent are some of the most important things a baby can receive.

At One Brooklyn Health Brookdale, we are honored to care for the babies and families in our community. Our goal is not only to help babies overcome challenges, but to help every child have the healthiest possible start and reach their fullest potential.